MEDICARE: MS. GABRIELLA BOOTH LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	12146	MA

General Provider Information

NPI Number	:	1497259626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GABRIELLA BOOTH LMT

Provider Business Mailing Address
First Line	:	245 RUSSELL ST UNIT 12
Second Line	:
City	:	HADLEY
State	:	MA
Zip	:	01035-9529
Country	:	US
Telephone Number	:	413-355-2009
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 RUSSELL ST UNIT 12
Second Line	:
City	:	HADLEY
State	:	MA
Zip	:	01035-9529
Country	:	US
Telephone Number	:	413-355-2009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2018
Last Update Date	:	03/21/2018

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